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NCCN Flash Updates: NCCN Resources Updated for Lung Cancer Screening and Colon and Rectal Cancers

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Lung Cancer Screening. These NCCN Guidelines® are currently available as Version 3.2018.

  • Follow-up of Screening Findings (LCS-3, LCS-4, LCS-7, LCS-8)
    • Footnote q modified: Criteria for suspicion of malignancy: hypermetabolism higher than the background of surrounding lung parenchyma greater than the adjacent mediastinal blood pool, regardless of absolute SUV.
       
  • The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)

*For your reference, the previous update (Version 2.2018) to the NCCN Guidelines for Lung Cancer Screening, published on August 9, 2017, is available at the following link: https://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf

 

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Colon Cancer and Rectal Cancer. These NCCN Guidelines for Colon Cancer are currently available as Version 1.2018. The NCCN Guidelines for Rectal Cancer are currently available as 4.2017.

  • Adjuvant Treatment (COL-3)
    • Stage III colon cancer treatment recommendations differentiated based on risk status
      • Low-risk stage III is defined as T1-3, N1
        • Preferred treatment recommendations include: CAPEOX for 3 months or FOLFOX for 3–6 months [category 1 for 6 months]
        • Other treatment options include: Capecitabine or 5-FU for 6 months
      • High-risk stage III is defined as T4, N 1-2; T any, N2
        • Preferred treatment recommendations include: CAPEOX for 3–6 months [category 1 for 6 mo] or FOLFOX for 6 months (category 1)
        • Other treatment options include: Capecitabine or 5-FU for 6 months
      • Footnote r added: “In patients staged as T1-3, N1 (low-risk stage III), 3 months of CAPEOX is non-inferior to 6 months of CAPEOX for disease-free survival; non-inferiority of 3 vs. 6 months FOLFOX has not been proven. In patients staged as T4, N 1-2 or T any, N2 (high-risk stage III), 3 months of FOLFOX is inferior to 6 months of FOLFOX for disease-free survival, whereas non-inferiority of 3 vs. 6 months CAPEOX has not been proven. Grade 3+ neurotoxicity rates are lower for patients who receive 3 months vs. 6 months of treatment (3% vs. 16% for FOLFOX; 3% vs. 9% for CAPEOX). Shi Q, et al. J Clin Oncol 2017;35 (suppl):LBA1.”
         
  • Workup of metastatic disease (COL-4, REC-6, REC-7, REC-9, REC-11)
    • Bullet 5 modified: “Determination of tumor gene status for RAS (KRAS and NRAS) and BRAF (individually or as part of next-generation sequencing [NGS] panel)” (COL-4)
    • Footnote t modified: Determination of tumor gene status for RAS (KRAS and NRAS) and BRAF (individually or as part of next-generation sequencing [NGS] panel). (REC-6, REC-7, REC-9, REC-11)
       
  • Unresectable metachronous metastases (COL-11, REC-11)
    • Primary treatment
      • Previous adjuvant FOLFOX/CAPEOX within past 12 months
        • The following regimen was added: “(Irinotecan + [cetuximab or panitumumab] + vemurafenib [BRAF V600E mutation positive])”
        • Footnote modified: “BRAF V600E mutation makes response to panitumumab or cetuximab highly unlikely unless given with a BRAF inhibitor.”
           
  • Principles of Imaging section added. (COL-A)
     
  • Principles of Pathologic Review (COL-B 4 of 5, REC-B 5 of 6)
    • KRAS, NRAS, and BRAF Testing
      • Bullet 1 modified: “All patients with metastatic colorectal cancer should have tumor tissue genotyped for RAS (KRAS and NRAS) and BRAF mutations. Patients with any known KRAS mutation (exon 2, 3, 4 or non-exon 2) or NRAS mutation (exon 2, 3, 4) should not be treated with either cetuximab or panitumumab. BRAF V600E mutation makes response to panitumumab or cetuximab highly unlikely unless given with a BRAF inhibitor.”
    • Microsatellite Instability (MSI) or Mismatch Repair (MMR) Testing
      • Bullet 5 added: “Testing for MSI may be accomplished with a validated NGS panel, especially in patients with metastatic disease who require genotyping of RAS and BRAF.”
      • Footnote * modified: “IHC for MMR and PCR DNA analysis for MSI are different assays measuring the same biological effect.
         
  • Continuum of Care – Systemic Therapy for Advanced or Metastatic Disease
    • Subsequent Therapy (COL-D 2 of 10, REC-E 2 of 10)
      • The following regimen was added: “Irinotecan + (cetuximab or panitumumab) + vemurafenib (BRAF V600E mutation positive)” (also applies to COL-D/REC-E 3 of 10, 4 of 10, 5 of 10)
    • Regimens added (COL-D/REC-E) 9 of 10:
      • Irinotecan + cetuximab + vemurafenib (BRAF V600E mutation positive): Irinotecan 180 mg/m2 IV every 14 days and cetuximab 500 mg/m2 IV every 14 days with vemurafenib 960 mg PO twice daily (reference added to COL-D/REC-E 10 of 10)
      • Irinotecan + panitumumab + vemurafenib (BRAF V600E mutation positive): Irinotecan 180 mg/m2 IV every 14 days and panitumumab 6 mg/kg IV over 60 minutes every 2 weeks with vemurafenib 960 mg PO twice daily
      • Pembrolizumab 200 mg every 3 weeks
         
  • Principles of Radiation Therapy (COL-E)
    • Bullet 4 added: Image-guided radiation therapy (IGRT) with kilovoltage (kV) imaging and cone-beam CT imaging should be routinely used during the course of treatment with IMRT and SBRT.
       
  • Principles of Survivorship (COL-H 1 of 2)
    • Management of Late/Long-Term Sequelae from of Disease or Treatment
      • Bullet 1 added: “For issues related to distress, pain, neuropathy, fatigue, or sexual dysfunction, see NCCN Guidelines for Survivorship”
      • Bullet 2, sub-bullet 2 added
        • Management of an ostomy
          • Consider participation in an ostomy support group or coordination of care with a health care provider specializing in ostomy care (i.e. ostomy nurse)
          • Screen for distress around body changes (See NCCN Guidelines for Distress Management) and precautions around involvement with physical activity (see page SPA-A in the NCCN Guidelines for Survivorship)
      • Bullet 3; sub-bullet added for oxaliplatin-induced neuropathy
        • Consider non-pharmacologic therapies, such as, heat, ice, or acupuncture
      • Counseling Regarding Healthy Lifestyle and Wellness
        • Bullet 1 added: “Undergo all age and gender-appropriate cancer and preventive health screenings as per national guidelines”
        • Bullet 5 modified: “Consider low-dose daily aspirin 325 mg for secondary prevention.”
        • Bullet 6 modified: “Eliminate or limit alcohol consumption, no more than 1 drink/day for women, and 2 drinks/day for men.
           
  • Staging in the NCCN Guidelines for Colon Cancer (ST-1)
    • Staging updated to reflect the changes in the AJCC Cancer Staging Manual, Eighth Edition (2016).
       
  • Global change – FLOX removed throughout the Guidelines

 

*For your reference, the previous update (Version 3.2017) to the NCCN Guidelines for Rectal Cancer, published on March 4, 2017, is available at the following link: https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf

 

The following NCCN Chemotherapy Order Templates (NCCN Templates®) have been deleted to reflect the NCCN Guidelines for Colon Cancer Version 1.2018.

  • COL26: FLOX (Fluorouracil/Leucovorin/OXALIplatin)

 

NCCN has published updates to the NCCN Radiation Therapy Compendium™ based on updates to the following NCCN Guidelines:

  • Colon Cancer, Version 1.2018
  • Testicular Cancer, Version 1.2018

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Templates®, the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

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